New anticoagulants come in the form of pills
For instance , NOACs should not be initiated in patients with active bleeding , and they ’ re not suitable for those with valvular atrial fibrillation and mechanical valves . This includes patients who have shown recent gastrointestinal bleeding or who have oesophageal varices , malignant neoplasms , hemorrhagic stroke , or recent intracranial bleed and vascular aneurysm . In addition , they ’ re not suitable for those who have undergone recent brain , spine , or eye surgery .
“ There needs to be careful assessment prior to starting NOACs in patients with significant risk of major bleeding . Also , in patients with renal impairment , there needs to be dose adjustment . Those with severe renal impairment should avoid dabigatran , while apixaban is contraindicated in severe liver disease ,” said Dr Suraya .
Other obstacles to their use include the higher cost of NOACs compared to warfarin and limited access to novel anticoagulants in some government healthcare systems .
In addition , doctors may be less familiar with NOACs , since they ’ ve been prescribing warfarin for many years . One common problem seems to be inappropriate dosing . Data from a 2017 study of almost 15,000 patients with atrial fibrillation showed that more than 13 percent of them were underdosed , even though there was no indication for a lower dose . This would potentially undermine the drugs ’ effectiveness .
From the same group , 1,500 had severe kidney disease , although 43 percent continued receiving the standard dose instead of a reduced dose . Given that the study took place in 2017 , it ’ s likely that more doctors are now adopting the precise protocols for NOAC prescriptions .
The most common potential side effects of these drugs include either minor bleeding , such as cases of bruising or gum bleed , or major bleeding in the gastrointestinal tract and intracranial bleeds . There may also be allergic reaction , dyspepsia and gastrointestinal symptoms .
Despite the success of novel anticoagulant therapies , there is still a major role for warfarin .
“ Warfarin may have a higher risk of bleeding and stroke in atrial fibrillation patients compared to novel oral anticoagulants , but it ’ s still superior to NOACs for those with mechanical valves or patients with valvular atrial fibrillation , such as moderate to severe mitral stenosis , and those who are unable to tolerate NOACs ,” said Dr Suraya . n
GlobalHealthAsiaPacific . com JUNE 2021
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